Medical Loss Ratio Guarantee. The FIDA Plan has a Target Medical Loss Ratio (TMLR) threshold of eighty-five (85) percent.
Medical Loss Ratio Guarantee. The Contractor has a Target Medical Loss Ratio of eighty-five percent (85%) for Demonstration Years 1 through 5, eighty-six percent (86%) for Demonstration Year 6, eighty- seven percent (87%) for Demonstration Year 7, and eighty-eight percent (88%) for Demonstration Year 8. As described below, any collected remittances would be distributed proportionally back to the Medicaid and Medicare programs on a percent of premium basis. If the Medical Loss Ratio calculated as set forth below is less than the Target Medical Loss Ratio, the Contractor shall refund to the Department and CMS an amount equal to the difference between the calculated Medical Loss Ratio and the Target Medical Loss Ratio (expressed as a percentage) multiplied by the Coverage Year Revenue. The Department and CMS shall calculate a Medical Loss Ratio for Enrollees under this Contract for each Coverage Year, and shall provide to the Contractor the amount to be refunded, if any, to the Department and CMS respectively. Any refunded amounts will be distributed back to the Medicaid and Medicare programs, with the amount to each payor based on the proportion between the Medicare and Medicaid Components. At the option of CMS and the Department, separately, any amount to be refunded may be recovered either by requiring the Contractor to make a payment or by an offset to future Capitation payment. The Medical Loss Ratio Calculation shall be determined as set forth below; however, the Department and CMS may adopt NAIC reporting standards and protocols after giving written notice to the Contractor.
Medical Loss Ratio Guarantee. Contractor has a Target Medical Loss Ratio of eighty-eight percent (88%). If the Medical Loss Ratio calculated as set forth below is less than the Target Medical Loss Ratio, Contractor shall refund to the State an amount equal to the difference between the calculated Medical Loss Ratio and the Target Medical Loss Ratio (expressed as a percentage) multiplied by the
Medical Loss Ratio Guarantee. (a) For each calendar quarter beginning July 1, 2009 during which the Contractor was under contract to the Department, if the Contractor’s Medical Loss Ratio (MLR) is less than 80%, the Department may recover by deduction from future payments a percentage of the quarter’s premium revenue equal to the difference between the reported MLR and 80%.
Medical Loss Ratio Guarantee. (a) For each calendar quarter that this contract is in effect, effective with the quarter beginning April 1, 2005, if the Contractor's Medical Loss Ratio (MLR) is less than 82%, the Department will recover by deduction from future payments a percentage of the quarter's premium revenue equal to the difference between the reported MLR and 82%.
Medical Loss Ratio Guarantee. 7.10.1 Contractor shall calculate, and report to the Department, a medical loss ratio (MLR) for each calendar year (MLR reporting year), consistent with MLR standards in 42 CFR 438.8(a). The MLR calculation shall be determined as set forth below; however, the Department may adopt NAIC reporting standards and protocols after giving written notice to Contractor.
Medical Loss Ratio Guarantee. Contractor has a Target Medical Loss Ratio of eighty-eight percent (88%) aggregate for all covered populations. If the Medical Loss Ratio calculated as set forth below is less than the Target Medical Loss Ratio, Contractor shall refund to the State an amount equal to the difference between the calculated Medical Loss Ratio and the Target Medical Loss Ratio (expressed as a percentage) multiplied by the Coverage Year Revenue. The Agency shall prepare a Medical Loss Ratio Calculation which shall summarize Contractor’s Medical Loss Ratio for Enrollees under this Contract for each Coverage Year. The Medical Loss Ratio Calculation shall be determined as set forth below; however, the Agency may adopt modified reporting standards and protocols after giving written notice to Contractor.
Medical Loss Ratio Guarantee. Contractor has a Target Medical Loss Ratio of eighty-eight percent (88%). If the Medical Loss Ratio calculated as set forth below is less than the Target Medical Loss Ratio, Contractor shall refund to the State an amount equal to the difference between the calculated Medical Loss Ratio and the Target Medical Loss Ratio (expressed as a percentage) multiplied by the Coverage Year Revenue. The Department shall prepare a Medical Loss Ratio Calculation which shall summarize Contractor’s Medical Loss Ratio for Enrollees under this Contract for each Coverage Year. The Medical Loss Ratio Calculation shall be determined as set forth below; however, the Department will use best efforts to evaluate the use of the National Association of Insurance Commissioner (―NAIC‖) definition of medical loss ratio for the purpose of calculating the Medical Loss Ratio, with the goal being adoption of as much of the NAIC definition as is consistent with the Department’s policy goals and interests prior to the initial calculation of Contractor’s Medical Loss Ratio. In the event the Department adopts some or all of NAIC guidelines for the calculation of the Medical Loss Ratio, the Department shall notify Contractor in writing. Notwithstanding the foregoing and independent of such evaluation of the NAIC definition of medical loss ratio, prior to the initial calculation of Contractor’s Medical Loss Ratio, the parties will work in good faith to detail the basis of calculating the Medical Loss Ratio including establishing sample calculations to demonstrate what is included and excluded from the Medical Loss Ratio.
